Interventional ASD closure in children weighing less than 10 kg can be performed without any additional major risks and shows a favorable outcome, especially in selected patients with significant non cardiac co-morbidities.

Background: Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno-and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. Methods: Tri-and bicuspid venous valves (n = 27) based on polyglycolic acid-poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bonemarrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n = 18) and experimentally delivered (n = 7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. Results: The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. Conclusions: Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of currently used non-autologous replacement materials and may open new therapeutic concepts for the treatment of CVI in the future.

with dorsal inlay of buccal mucosa and tubularization. Our objective is to evaluate success of each procedure.METHODS: We prospectively reviewed the charts for those who underwent staged repair for multiple failed hypospadias and complex strictures.42 patients were included in the study.The time period was from 2010 to 2018 where we did Johnsson's Staged Urethroplasty followed by the second stage with dorsal inlay buccal graft augmentation and urethral tulbularisation.RESULTS: Mean age of was 34.5 years .We see young adults with multiple failed hypospadias .The last patient was operated 7 times before being referred to us as hypospadias cripple, stricture and multiple urethrocutaneous fistula. After a mean follow up of 16 (6-45 months), none of the patients needed redo graft placement for urethral stricture or recurrence.1 patient had glans dehiscence and 1 had complete dehiscence due to infection.3 patients has urethrocutaneous fistula which were closed subsequently.CONCLUSIONS: Complex Penile Stricture and Hypospadias cripple patients can be managed with staged urethroplasty with placement of BMG graft to aid a failing urethral plate. Placing the BMG during the second stage rather than contemporary first stage is superior to the technique of BMG placement during first stage. This modification decreases patient morbidity, improves success, and results in a small, but significant paradigm shift in the management of failed hypospadias. Larger multinstitutional studies are required to substantiate our experience.We present our long term results which prove the feasibility, efficacy and success of this approach.

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